A REGIONAL APPROACH TO PROVIDING BETTER FIRE PROTECTION AND EMERGENCY MEDICAL SERVICES TO SANTA BARBARA COUNTY’S RESIDENTS

INTRODUCTION

When your home or business catches on fire, or you are involved in an automobile injury accident, or feel unusual chest pains after mowing the lawn, you and your family want, expect and need the fastest and best professional help you can get to avoid a serious loss, injury, or, even, death.

Realizing the geographic complexities and scattered dispersal of this County’s population outside of its major cities, Santa Barbara, Santa Maria and Lompoc, and knowing that fire protection and emergency medical services are provided by many different and often independent governmental and quasi-governmental agencies in various places throughout the County, the Grand Jury formed an investigative committee to study and report on the questions of whether existing fire protection and emergency medical services could be improved, and if so, how.

The following report, findings and recommendations are the product of a 10-month investigation during which 45 witnesses were interviewed, and dispatch facilities in Santa Barbara, Ventura and San Mateo Counties were visited.

BACKGROUND DEMOGRAPHICS AND SCOPE OF INVESTIGATION

Santa Barbara County, with a population of 399,347 according to the last census, and a total area of 2,744 square miles, has nine different and independent fire protection agencies, each with its own chief, separate governing body and administration:

The full-time professional firefighters have their own unions, except for Montecito, which is non-union. Each fire chief and each union representative was interviewed.

Some of the fire chiefs were interviewed several times and members of the governing boards of two of the independent fire districts were also interviewed. Additionally, in order to see how various regionalized fire districts were organized and conducted their business, the committee met with Fire Chiefs from San Luis Obispo, Sacramento, Orange and San Bernardino Counties, as well as with the founders of the COVE Communities

Public Safety Commission in Riverside County. COVE consists of three desert communities adjacent to Palm Springs.

In Santa Barbara County, Emergency Medical Service (EMS) is provided by fire paramedics employed by the various fire departments and American Medical Response (AMR) provides ambulance service. Both are under the general control of the County’s Public Health Department1. The Medical and Administrative directors of EMS for the Health Department were interviewed extensively as was the Santa Barbara County Operations Director for AMR.

Additionally, the committee traveled to San Mateo to meet with the Director and various members of that county’s EMS team because they had developed a new and promising approach to providing EMS.

Emergency dispatch is provided by various agencies in various ways. There is no centralized emergency dispatch of any kind, and there is no separate fire or EMS dispatch system within Santa Barbara County.

The Santa Barbara, Santa Maria and Lompoc Police Departments provide dispatch for both fire and law enforcement calls within their cities.

The Sheriff provides law-enforcement dispatch for his own force and for Carpinteria, Buellton, Solvang and Guadalupe. The Sheriff also provides primary fire dispatch for the County Fire District, for Solvang, Guadalupe and Orcutt, and provides ambulance dispatch for the entire County.

Additionally, the Carpinteria-Summerland and Montecito Fire Districts provide secondary dispatch (i.e., after the call is first taken and analyzed by a law-enforcement dispatch center) within their own districts. In about 75% of calls, the message is repeated by the first call taker to the secondary dispatcher.

No dispatching agency in Santa Barbara County can electronically and automatically communicate with any other dispatching agency in the County. All inter-agency communication in the County is done by telephone.

The Sheriff and his dispatch personnel were interviewed, as were the dispatch personnel of the Santa Barbara Police Department, of Ventura and San Mateo Counties, and of the California Highway Patrol (CHP) which, by law, currently receives and passes on all 9-1-1 cell phone calls2.

The committee also met with representatives of the California Department of Forestry (CDF), and discussed the possibility and costs of having that agency assume all fire protection services in the County.

Finally, the Grand Jury requested the County Auditor-Controller to perform a cost and performance analysis of the fire and EMS services throughout the County, and extensively discussed that analysis with the Auditor, the County Administrative Officer and the Executive Officer of the Santa Barbara County Local Agency Formation Commission (LAFCO).

The Jury is grateful to the Auditor-Controller and his staff for the time and effort expended in promptly completing the requested analyses.

SUMMARY OF OUR FINDINGS AND RECOMMENDATIONS

In addition to considering contracting with the California Department of Forestry for fire protection services for all or some parts of the County, serious consideration should also be given to consolidating the nine separate fire departments now existing in the County into a new County-wide fire protection district beginning first with the Santa Barbara City, County, and Carpinteria-Summerland Departments, and then continuing into the North County as revenue sources permit.

The dispatching of Fire and Emergency Medical Services should be centralized as soon as possible, and with the following components: automatic prioritization of dispatch,

automatic vehicle location (AVL), pre-arrival emergency medical instruction (EMD), and automatic electronic interfacing among all computer assisted dispatch (CAD) systems.

A BRIEF LOOK AT EXISTING FIRE PROTECTION AND EMS SERVICES

Existing Fire Protection Services

As noted, the Cities of Santa Barbara, Santa Maria, Lompoc, Solvang and Guadalupe have their own separate and independent fire departments governed by their City Managers and Councils. Santa Barbara County is a dependent but separate fire district governed by the Board of Supervisors; and Carpinteria-Summerland, Orcutt and Montecito are independent fire districts each governed by a three-member elected Board of Directors.

Except for the firefighters in Solvang and Orcutt who volunteer their services (without any pay in the case of Orcutt and with only hourly pay for actual fire fighting in the case of Solvang), these nine fire departments employ 507 people (of whom 398 are firefighters, 46 are in administration and 48 are in fire prevention). They staff 35 fire stations throughout the County as shown on the accompanying map, Appendix A.

Those fire stations are equipped with 57 first-out fire engines, 13 reserve fire engines, 157 other vehicles, and two helicopters, to protect approximately 127,400 structures. They also protect 687,579 acres of forest, designated as State Responsibility Acreage (SRA land), which the County Fire Department has the responsibility for protecting under contract with CDF. These services are provided from various fire stations as well as 12 administrative buildings, and cost a total of $53,153,000 in 2000. That cost will increase substantially under a new labor contract for County firefighters negotiated in March 2001.

In 2000 the nine fire departments responded to 25,078 emergency calls, of which 15,316 (or 61%) were for EMS, 1,829 (or 5%) were for fire, 1,356 (or 4.8%) were for hazardous conditions, and 6,577 (or 26%) were for miscellaneous matters, such as being locked out of house or car and animal rescues. The high proportion of these miscellaneous calls, more than for fire and hazardous materials combined, suggests a question as to whether that part of fire department work can or should be reduced in the name of economy and efficiency. What if a single, three-man fire station were not occupied when a life threatening emergency occurred?

While fire suppression calls were a small fraction of the calls responded to, each fire suppression call represented a real threat of serious loss. Moreover, the fire prevention campaigns (fire codes, sprinklered buildings, public education) operated by the various fire departments over the years have effectively reduced the number of fire suppression calls which need to be responded to today.

Existing Emergency Medical Service System

The EMS Section of the Public Health Department is the designated manager for the County-wide EMS system. It supervises the contract with AMR for County-wide ambulance service, and endeavors to coordinate the AMR and fire paramedic programs, as well as County Fire’s limited ambulance service.

The County Fire Department provides Advance Life Support (ALS) ambulance service at two stations: No. 51 at Vandenberg Village and No. 41 at New Cuyama. County Fire also provides paramedic services at Station No. 11 in Goleta, Station No. 24 in Los Alamos, Station No. 32 in Santa Ynez, and Station No. 22 in Orcutt. Montecito and Carpinteria-Summerland also provide paramedic service. For the remainder of the County Fire Stations, and all the City Fire Stations (including Santa Barbara, Santa Maria, Lompoc, Solvang and Guadalupe) no paramedic service is provided. In most cases, however, all firefighters in the County are qualified to give basic life support as emergency medical technicians (EMTs), many with defibrillator qualifications as well (EMT-Ds).

ALS ambulance service is provided throughout the County by AMR under contract with the County. AMR provides 18 ALS ambulances, and stations them at six locations throughout the County as shown on the accompanying map. (See Appendix B). That map also shows locations where additional paramedic and/or ALS ambulance services might be provided in the future.

Existing Fire and EMS Emergency Dispatch Systems

By law all 9-1-1 calls must be answered by a law enforcement agency. As a result, fire and EMS calls received through the 9-1-1 system cannot be directly received by the fire or EMS departments, but must first be routed through the appropriate law enforcement agency for the jurisdiction.

Fire and EMS emergency dispatch is handled by a variety of public agencies in a variety of ways. The Sheriff handles all primary ambulance dispatch in the County as well as primary dispatch for the County Fire Department and for the Solvang, Guadalupe, and Orcutt Fire Departments.

The police departments of the Cities of Santa Barbara, Santa Maria, and Lompoc provide fire dispatch for their own fire departments within city boundaries; and Carpinteria-Summerland and Montecito provide secondary dispatch to their fire departments in their geographic areas.

Only one dispatch center (Santa Barbara Police Department’s) currently provides Emergency Medical Dispatch (EMD); i.e., pre-hospital/pre-arrival emergency medical instructions to the injured victim or to the caller. In other words, no EMD services are provided to the vast majority of the County’s residents3.

Moreover, while all of the dispatch centers have computer assisted dispatch (CAD) capabilities, each of the four law enforcement dispatch centers has a different CAD system, and none of them can or do electronically speak to each other. All communication between dispatch centers is therefore currently done by telephone.

For example: if a 9-1-1 cell phone call is received by the CHP for an emergency occurring within Santa Barbara City limits, CHP must transmit that call by telephone to the Santa Barbara Police Department if it involves law enforcement, or to the Sheriff if it involves ambulance dispatch. In either case, if the call also involves a fire, or a possible response by a fire paramedic, the Police Department and/or the Sheriff must relay the call by telephone to the affected fire department. As a result, errors or time delays creep into the system through human fallibility in making the numerous telephone calls required for all affected agencies to communicate with each other.

These problems are particularly troubling because, as will be more fully developed below, the response times vary widely throughout the County due to the dispersed nature of the cities and other population centers.

Evaluation of the Existing Fire Protection Systems

Table I Fire Department Expense ($ in thousands) for 2000

 

County of Sta. Barbara

City of Santa Barbara

City of Lompoc

City of Santa Maria

Carpinteria-Summerland

Montecito

Total Expense

$26,815

$11,015

$2,074

$3,969

$3,408

$4,994

Fire Chief

$164

$144

$117

$139

$139

$161

Admin Expense

$2,5674

$317

$41

$88

$68

$172

As % of Total Exp.

9.56%

2.88%

1.6%

2.21%

2%

3.55%

Staff

34

6

1

2

1

2

Fire Prevent. Exp.

$1,919

$694

$101

$88

$68

$172

As % of Total Exp.

7.14%

6.3%

4%

5.7%

3%

3.4%

Staff

27

11

1

4

1

4

Firefighters

$16,6395

$8,505

$1,815

$2,402

$2,793

$3,204

As % of Total Exp.

62%

77.2%

74.8%

60.5%

82%

64.2%

Excludes the Fire Departments of Orcutt, Solvang, and Guadalupe

 

Table II Fire Department Cost of Performance Comparisons for 2000

 

County of Santa Barbara

City of Santa Barbara

City of Lompoc

City of Santa Maria

Carpinteria-Summerland

Montecito

No. of Structures

37,556

35,000

13,950

22,000

8,000

4,000

Cost per Structure

$715

$315

$149

$180

$426

$1,249

 

 

 

 

 

 

 

No. of Calls

7,734

6,080

1,700

4,475

1,295

962

Cost per Call

$3,472

$1,812

$1,220

$887

$1,136

$5,191

 

 

 

 

 

 

 

No. of Stations

15

8

2

3

2

2

Cost per Station

$1,790,000

$1,377,000

$1,037,000

$1,323,000

$1,136,000

$2,499,000

 

 

 

 

 

 

 

Population Served

165,737

92,325

41,103

77,423

14,144

10,000

Cost per Person

$162

$119

$59

$51

$241

$499

Average Response Time-Urban Calls

7.5 minutes

4.1 minutes

4.1 minutes

5.9 minutes

4.3 minutes

4.6 minutes

Excludes the Fire Departments of Orcutt, Solvang, and Guadalupe

According to County Fire’s recent Critical Needs Assessment, the flashpoint of a fire occurs approximately 10 minutes after ignition. The national standard for fire suppression response is to have a chief and 12 firefighters on the scene of the fire before then. County Fire cannot meet that standard. It can only put a chief and eight firefighters on the scene within 10 minutes under the best of circumstances.

Some of County Fire’s Stations are so remote (e.g., New Cuyama) that they will never come close to meeting that standard. Indeed, effective response (nine men on the scene within approximately 10 minutes) can only be rendered by six of the County’s Fire Stations, and most of them are located in relatively urban areas in the South Coast. Of the remaining eight stations, the effective response times are:

Station 15, Foothill Rd., 25 minutes 48 seconds

Station 21, Santa Maria Airport, 26 minutes 12 seconds

Station 22, South Orcutt, 30 minutes 0 seconds

Station 23, Sisquoc, 21 minutes 37 seconds

Station 24, Los Alamos, 15 minutes 51 seconds

Station 32, Santa Ynez Airport, 19 minutes 45 seconds

Station 41, New Cuyama, 38 minutes 10 seconds

Station 51, Vandenberg Village, 28 minutes 33 seconds

County Fire’s recent Critical Needs Assessment also describes the highest fire and life-safety hazards in the County as existing in Isla Vista, particularly at UCSB, and in the Buellton, Solvang and Santa Ynez area, particularly at the Chumash Casino.6 Thus, the Critical Needs Assessment states that the national average of on-duty staffing is 0.48 firefighters per 1,000 population. Current County Fire staffing is: Goleta Valley 0.26; Santa Ynez Valley 0.37; Santa Maria Valley 0.37; UCSB 0.10; and the entire County Fire District 0.30.

Evaluation of the Existing EMS and Fire-EMS Dispatch Systems

The EMS System

As noted, Advanced Life Support (ALS) ambulance service is provided by two agencies: County Fire and AMR. AMR provides ALS ambulance service (one paramedic and one EMT/ambulance) to most of the county by means of 18 ambulances dispatched from six locations throughout the county. County Fire provides ALS ambulance service only to Vandenberg Village and the remote town of New Cuyama. The County’s cost to provide the ambulance service to Vandenberg Village is essentially paid for by a local oil company. The cost to provide ambulance service to New Cuyama is partially paid for by CDF under its State Responsibility Acreage (SRA land) contract with the County. While New Cuyama is somewhat isolated in the most northern part of the County, its Fire Station has mutual aid agreements with Maricopa and Taft in Kern County, and the most serious medical problems are evacuated by helicopter.

As further noted, County Fire only provides fire paramedic services out of its Goleta, Santa Ynez, Los Alamos and Orcutt stations. County Fire currently employs 21 fire paramedics at a cost of $80,995 each per year. AMR currently employs 33 paramedics at a cost, at its highest rate based on seniority and workweek hours, of $50,074 each per year. Carpinteria-Summerland currently employs nine paramedics at a cost of approximately $53,244 each per year.

A question arises as to whether the County should cease providing paramedic service entirely, and turn that service over entirely to AMR.

Those areas of the County in which County Fire or the Carpinteria-Summerland Fire Protection District does not provide paramedic service are all currently served by AMR. On the other hand, the fire departments are usually first on the scene of any accident, and so provide first response in most cases. Shouldn’t the fire departments have fire paramedics on every fire engine? That is the basic assumption of the San Mateo Plan described later.

The Fire-EMS Dispatch Systems

As noted, at least six agencies are involved in Fire-EMS dispatch, and none can automatically and electronically communicate with each other (i.e., there is no CAD-to-CAD electronic interface). While such technology currently exists, the Grand Jury has not been able to secure even an estimate of the cost of interfacing the four different CAD systems now existing in the County: the Sheriff’s and the Santa Barbara, Santa Maria, and Lompoc Police Departments’. Nevertheless, such interfacing will eventually be needed to bring Santa Barbara into the 21st Century.

Except for the City of Santa Barbara, there are no pre-arrival/pre-hospital emergency medical instructions (EMD) given to anyone by any of the other five dispatch centers. Since EMD has become the standard for good emergency dispatch systems, the County’s lack of such a capability seems to be a glaring deficiency.

The Fire Chiefs, AMR, and County EMS all complain that the Sheriff’s Tiburon CAD system is designed for law enforcement dispatch and has never been effectively modified to provide good fire and ambulance dispatch. They all recommend that a different CAD system that is designed for fire and EMS, as well as law enforcement dispatch, such as the American Tri-tech VISI CAD system, be installed, because fire and EMS dispatch is inherently different from law enforcement dispatch.7

The Sheriff’s dispatch center is located in the County’s Public Safety Dispatch Center on the campus of the Sheriff’s Administration and Main Jail facilities. It was opened in March 1997 and designed to house all of the public safety dispatch systems, including fire and EMS.

The response to fire and EMS incidents is neither accurately nor uniformly timed. Indeed, no mechanism currently exists to record accurately the time at which either the first responders (usually firefighters) or ambulance crews arrive at the scene. This results in a situation in which it is impossible to track accurately total response time for any incident. Accordingly, there is no precise way to measure performance.

The Sheriff’s Tiburon computer assisted dispatch system has not been modified to provide for automatic vehicle location (AVL). Modification to permit AVL will allow for the relocation of back-up assets during an emergency response to provide better coverage for any interim emergencies in the same location or adjacent area. Increasing the options and strategies for the most effective deployment of assets is an important capability.

Currently there is no structured caller interrogation or advanced prioritized dispatch system in place. As a result, most emergency vehicles (fire and ambulance) are dispatched to an incident "Code 3," i.e., with maximum speed and with red lights and sirens, regardless of the urgency of the incident. The inefficiency and waste in such a system is apparent.

Finally, there is no system currently in place to track the effectiveness of EMS response so as to measure success and improve the system of patient care. For example, it is not currently possible to determine with any accuracy how many fire paramedics are needed in the system, or where to locate them for best patient care. Moreover, there is no system in place or contemplated to determine the quality of patient care by measuring outcomes.

EXPLORING SOME IMPROVEMENTS TO THE SYSTEMS

Consolidation of the Nine Fire Departments into One or More New Fire Districts

The Grand Jury has reviewed considerable literature on this subject; has met with the Fire Chiefs involved and analyzed fire department consolidations in Orange, San Bernardino, San Mateo and Sacramento Counties; and has spoken at some length with our own Fire Chiefs and Firefighter Union representatives. As a result, the Grand Jury believes that consolidation of all the existing fire departments into one or more new independent fire districts has considerable merit.

The Pros

Everyone interviewed has stated that consolidation produces more effective fire protection and life saving. The reasons for consolidation are often stated as follows:

The Cons

The arguments against consolidation are often stated as follows:

The Experience Of Other Fire Department Consolidations in the State

The Grand Jury has reviewed consolidations of Fire Departments in Sacramento, Orange, San Mateo and San Bernardino Counties. All were much larger in scope than the consolidation being discussed here, and all were successful. Each was started for a somewhat different reason and each took considerable time. The principal lesson learned is that it takes substantial political will and patience to bring about a consolidation.

Sacramento

The Sacramento Metropolitan Fire District was finally formed in December 2000 from 16 predecessor fire agencies formed during the 1940’s. The consolidation process took 14 years, and was finalized when the American River and Sacramento County Fire Protection Districts were merged.

This District provides services through 41 fire stations and approximately 700 personnel to nearly 600,000 people in a 417 square-mile area. The consolidation began, as Santa Barbara’s might, with the centralization of the various fire dispatch systems.

The District is an independent fire protection district run by a board of nine elected directors formed under the 1987 Bergeson Fire District Law. Its Chief praises its efficiency and cost effectiveness. However, he urges anyone who attempts such a consolidation to be patient.

Orange County

The Orange County Fire Authority was essentially formed as a result of the County’s bankruptcy. Before 1980 it was a California Department of Forestry (CDF) operation serving rural Orange County under contract with the Orange County Board of Supervisors. When CDF decided to discontinue service in 1980, the County formed its own fire department.

When the County went bankrupt in 1994, the Department was separated from the County. It became an independent Joint Powers Agency (JPA) in 1995, and provides fire protection for 19 cities and a large unincorporated area. A 21-member board of directors representing each of the 19 cities and two Supervisors representing the County administers it. The Authority has been able not only to save money by reducing overhead, but also to relocate and add fire stations for better and more efficient coverage.

San Mateo

Nineteen cities in San Mateo County joined together in December 1998 to form a JPA for the purpose of providing better emergency medical service for their 675,000 residents. At the time, several cities had full fire paramedic service in their fire departments, while other cities’ fire departments only had licensed EMTs. The County’s ambulance service provided additional paramedic services, but response times were uneven and generally thought to be unsatisfactory, though accurate measurement was not possible. The level of emergency medical care seemed substandard. Coordination among the many cities was difficult. The fragmented system meant that the quality of pre-hospital care could vary widely from one city to another.

The JPA was formed to remedy that situation. It entered into a partnership with the County’s ambulance provider, AMR, under which AMR agreed to help finance the first- response fire paramedic system in order to make both first (fire paramedic) and second (ambulance) responses more effective. Detailed standards were established, including a series of graduated fines for late response.

To date the San Mateo Plan has worked as designed. The number of fire paramedics has been increased from 60 to 220. Fire paramedic first response has met its response times 98% of the time. Ambulance second response has met its response times 95% of the time.

Complete tracking of patient care, from receipt of the 9-1-1 call to discharge of the patient from the emergency room, is now being put in place by means of a fully integrated (from the dispatch center through the hospital) computerized record-keeping system, including the use of Palm Pilot type devices by paramedics. All of the participants in this venture expressed their enthusiasm for it and its patient benefits.

While this creative system seems ideal, the cost to the injured victim is high, about 50% more than the victim pays in Santa Barbara County. Whether the San Mateo Plan should be adopted here will be discussed later.

San Bernardino

The present San Bernardino County Fire Department is the result of a consolidation plan adopted in March 1997 whereby the Department took over a large unincorporated area from CDF called County Service Area 38. The Department provides services to 64 cities and communities over 16,225 square miles (from Los Angeles County to the Arizona and Nevada border), through 63 fire stations staffed by 525 full time firefighters.

The 1997 consolidation involved bringing the CDF firefighters who had formerly served County Service Area 38 into the Department. CDF firefighters work 72-hour weeks; other firefighters work 56-hour weeks.

The Department kept the 72-hour workweek for those firefighters but will phase it out as those workers leave. The Chief emphasized the need for political will and patience in bringing about fire department consolidations, but said he was pleased with what had been done in San Bernardino.

Financial Feasibility and Cost Effectiveness of Fire Department Consolidation

Revenues are Sufficient to Support a Single County-Wide District

Because of the far higher property-tax base existing in the South Coast, if consolidation is pursued it appears that a single County-wide fire district is the only financially feasible way to consolidate the existing nine departments. A single, County-wide district is also the most cost-effective and logical: one governmental agency and chain of command instead of two or three.

However, the people interviewed on this question indicate that at least two districts should be formed, one in South County and one in North County. As a result, the Grand Jury has analyzed the data with three potential districts in mind.

As noted, the cost to provide fire protection in Santa Barbara County in 2000 was $53,153,000. The revenues to pay for those costs, including general fund contributions by cities to make up for their lower property-tax revenues, but less mitigation, totaled $53,391,000; or $238,000 in excess of the costs.

If those revenues were spread out over three possible districts—a South County District, a Central County District and a North County District—the results would be as follows based on 2000 revenues and costs:

South County District

The District is comprised of Carpinteria-Summerland, Montecito, Santa Barbara City and the South Coast area of Santa Barbara County. It would have revenues of $31,929,000, expenses of $30,265,000, and an excess of $1,664,000.9

Montecito’s Chief and Board have indicated that, while they support and would equitably contribute to a centralized Fire-EMS dispatch system (to be discussed below), they will not now or in the foreseeable future join any consolidated fire district with the City or County of Santa Barbara. If Montecito were to be excluded, revenues and expenses would be reduced by $5,685,000 and $4,994,000, respectively, still leaving an excess of $973,000.

Central County District

This District comprises Solvang, Lompoc, Buellton, and the central area of Santa Barbara County. It would have revenues of $10,669,000, expenses of $10,157,000, and an excess of $512,000.

North County District

This District comprises Orcutt, Santa Maria, Guadalupe and the northern area of Santa Barbara County. It would have revenues of $10,794,000, expenses of $12,732,000, and a shortfall of $1,938,000.

While several of the Fire Chiefs have expressed a desire that, if consolidation is pursued, it should be done along the lines of the three districts described above, it appears that without substantial subsidies from some source, a single County-wide fire district is the only economically feasible way to consolidate.

Potential Cost Savings Which Might Result From Consolidation

While the timing and extent of cost savings is unknown, the potential annual cost savings that may be realizable are as follows:

There is a question as to whether the number of fire paramedics should be increased (as in San Mateo), or eliminated entirely (as is the case with all of the cities in the County). As also noted, a County fire paramedic is currently paid $80,995 annually, whereas the highest paid AMR paramedic is currently paid $50,074. The salary of the highest paid fire paramedic in Carpinteria-Summerland is $53,244 annually.

To the extent that it may be decided to do away with fire paramedics in the County, some additional savings might be realized. On the other hand, as noted later, under a San Mateo type of plan, fire paramedics could provide all paramedic services, and ambulances would only be used for transport.

Form of the Consolidation

While some consolidations have taken the form of joint powers agencies, the tax ramifications of Proposition 172 make independent fire districts organized under the 1987 Bergeson Fire District Law the preferred way to go from a revenue standpoint. Since revenue is critical here, an independent fire district seems to be the best approach. The reason is that Proposition 172 requires counties, but not properly organized independent fire districts, to return a significant portion of property tax revenues to the State Educational Revenue Augmentation Fund (ERAF) for public schools.

While it appears that a single, County-wide fire district is the most logical and efficient choice (indeed, from a revenue standpoint it may be the only viable way to go), it also appears that such a single, County-wide district cannot be formed initially.

It is suggested, therefore, that regionalization of fire protection services in the County begin in the South Coast by merging the Santa Barbara County Fire District, the Santa Barbara City Fire Department, and the Carpinteria-Summerland Fire Protection District into a new fire district, leaving the North County fire departments to join that new district when and if they see fit. As noted, because of present revenue constraints it is unlikely that they will be able to form a separate North County fire district in the foreseeable future.

As to governance of the new fire district, other fire department consolidations in the State suggest that the most successful fire district governance is representative of all the communities. The directors should be elected by the voters within those communities, on a community, rather than on a district-wide, basis. Thus, in this case, three directors seem to the Grand Jury to be the right number for the initial South Coast district: one from the City of Santa Barbara, one from Carpinteria-Summerland, and one from the County.

Centralization of Fire and EMS Dispatching

For the reasons stated in our evaluation of the existing Fire-EMS dispatch systems above, the Grand Jury strongly believes that centralizing Fire-EMS dispatch, with an EMD component, is an option whose time has come. The County’s Fire Chiefs, the directors of its two existing independent fire districts, and the Sheriff have all stated that they agree. So the question is not whether, but how best, to do it. There are several issues and options.

Where To Put It

Because of the wonders of modern communications technology, the system can be put anywhere: in a fire or police station with room enough to house it; in a rented office if the "going private" option is decided upon; or in the County’s Public Safety Communications Center now operated by the Sheriff.

The latter facility seems logical from many standpoints, not the least of which is that it has sufficient room and is the purpose for which the facility was designed. If this facility is chosen, however, there must be a genuine accommodation and reconciliation of views between the Sheriff and his dispatch personnel on the one hand, and the fire chiefs and the management of County EMS and AMR on the other.

The Sheriff wants all dispatch personnel to be cross-trained so as to be interchangeable and thus able to handle law enforcement as well as fire and EMS dispatch calls. The Sheriff claims that "his" Tiburon CAD system can adequately dispatch Fire-EMS calls, and can be modified to interface electronically with the remaining dispatch systems in the County such as the various city police departments.

The Fire Chiefs and the management of County EMS and AMR argue that the Tiburon CAD system will not produce the best results and should be replaced by an allegedly more Fire-friendly and EMS-friendly system such as Tri-tech. They further argue that the Fire-EMS dispatch computers and dispatchers should be separated from law enforcement dispatching, and placed under their own (not the Sheriff’s) command.

The evidence suggests that a compromise should work if the so-called "Sheriff’s dispatch center" is used.

An effective dispatch system should have dedicated call takers (like Ventura and San Mateo Counties) who receive and route all calls to either the law enforcement or the Fire-EMS dispatchers, or to both, as warranted. These call takers also could perform EMD duties.

The Fire-EMS dispatchers should be provided a CAD system built for their use. Independent experts should decide whether such a CAD system is Tiburon’s, Tri-tech's, or some other system such as Intergraph.

The Tiburon system is five-years old and has had its problems, particularly in the integration of new upgrades. Whichever system is selected, that system should be used for both law enforcement and Fire-EMS dispatching if both function in the same facility. The Grand Jury has been advised that it is neither cost efficient, nor, perhaps, even technically possible, to integrate and operate two different systems in the same dispatch center.

While there will undoubtedly be specialists, all dispatchers should be competent and willing to handle both law enforcement and Fire-EMS dispatch, if for no other reason than to avoid boredom, jealousy, and depression. Both the Ventura and San Mateo Counties’ dispatch systems rotate dispatchers routinely for both cost and efficiency reasons.

While separate supervision should not be required, the EMS Medical Director and/or a Battalion Fire Chief always should be on call to handle major events and disasters.

Should the System Be Public or Private, and Who Should Run It

The Sheriff has presented a detailed Fire-EMS dispatch model, located in the Public Safety Communications Center he now runs, using his Tiburon CAD system, and including an EMD but not an Automatic Vehicle Location (AVL) component. His dispatch personnel have estimated that such a system would cost approximately $22,000 for new equipment (without computer interfacing, or a new or different CAD system such as Tri-tech, but using existing County EMS’s EMD protocol cards now used by the Santa Barbara Police Department); and approximately $789,000 per year, plus 17% overhead, to operate. The EMD component alone costs approximately $268,000 per year. Adding an AVL component would increase the cost considerably. See below.

AMR has presented a privately operated Fire-EMS dispatch model, using the Tri-tech CAD system, and including EMD and AVL (ambulance only) components, but located in rented space. That system is estimated to cost approximately $418,600 for space and entirely new computer equipment (including the Tri-tech CAD system with Dr. Clausen’s industry standard EMD and AVL components), and approximately $608,344 per year to operate. For ambulances alone, the AVL equipment costs approximately $77,000. If AVL were extended to all 57 first-out fire engines in the County, the additional cost might be as high as $215,600.

There are good arguments for both public and private systems. The choice boils down to public-safety authority control, particularly in disaster situations, on the one hand, and economy on the other.

Whichever choice is made, the Fire-EMS dispatch system should be controlled by a Joint Powers Authority (JPA). If the Fire-EMS dispatch system is located in the County’s Public Safety Dispatch Center, that entire Center, including law enforcement dispatch, should be governed by a JPA whose Board should be made up of a representative of the Sheriff, a representative of the Fire District(s), and a representative of County EMS.

The County’s Public Safety Communications Center was originally intended to be a JPA, and run by such a Board. This suggestion would return the dispatch center back to what was originally intended.

Effective Consolidation Through Prioritized Dispatch

A prioritized dispatch should be established, as in San Mateo. The effect of that prioritization (requiring the closest unit to the incident to respond first, regardless of political boundaries) would be effectively to consolidate fire department response.

Adoption of the San Mateo EMS Plan

San Mateo County has a population of approximately 700,000 spread over 552 square miles from Daly City on the north to Palo Alto on the south, and from Half Moon Bay and the Pacific Ocean on the west to San Francisco Bay on the east.

In 1998, 13 of San Mateo County’s 20 cities had their own fire departments and dispatch centers, and the remaining seven were served by Fire Protection Districts which also had their own dispatch centers. EMS and pre-hospital first response was provided by 17 separate agencies. There were no uniform standards for training or medical equipment or supplies. This fragmented system of pre-hospital care varied widely from one community to another. The challenge was to find a way to have a uniform and consistent level of high-quality, pre-hospital, advanced life support (ALS) care for everyone in the County regardless of location.

In December 1998, after two years of planning, an innovative plan was adopted for Fire-EMS dispatch coupled with EMS delivery that capitalized on the strengths of first response by 17 fire departments in the County, and the expertise and financial support of AMR.

A public-private partnership was formed to provide a higher level of EMS patient care at essentially the same cost as previously existed, and under a system whereby performance could be measured both in terms of response and quality of care. It appears to have worked. The City of San Bernardino was so impressed it recently adopted a version of the San Mateo Plan. Here is how the plan works.

Essentially there are four parties: a Centralized Dispatch System under the control of its own JPA, County EMS, AMR, and 17 separate Fire Departments joined together for delivery of ALS paramedic services under a different Joint Powers Authority which in turn contracts with AMR, Central Dispatch and County EMS to provide the various services for which each is responsible. The aim of this joint venture was to decrease response times and increase the number and quality of the County’s fire paramedics so that the fire departments, as the first responders to most incidents, would be able to provide high quality ALS to injured victims in the most timely fashion. However, none of the fire departments had the funds to hire, train and maintain a sufficient number of fire paramedics to staff their total of 60 first-out fire engines 24 hours per day, seven days per week.

As a result, San Mateo awarded AMR an exclusive five-year contract, with two, two-year extension clauses, to provide the entire County with enough ambulances (at no charge to the County and staffed with one paramedic and one EMT) to meet a 12 minute 59 second response standard, 95% of the time.

Under a subcontract, AMR pays the JPA $3.6 million per year to finance the 17 fire departments’ first response paramedic program with the stipulation that first response be provided within 6 minutes 50 seconds, 95% of the time. AMR also furnishes the medical supplies and paramedic equipment for all of the fire engines, as well as training for paramedic certification. It was estimated that it would take about 200 paramedics to meet this standard. Both AMR and the fire departments are fined for late response. The $3.6 million per year and fines are distributed by the JPA according to various formulas.

Key to this entire concept is a central dispatch system that automatically dispatches fire engines and ambulances on a priority basis from the closest available units regardless of what city or political entity that unit is located in or owned by. Accordingly, the EMS JPA contracts with the San Mateo County Dispatch Center to provide such automatic priority dispatching, as well as automatic priority back-up deployment. Under its "PRC" CAD system, EMS calls are dispatched simultaneously by two separate dispatchers, one serving the engine companies and one serving the ambulances, within 60 seconds from the time the emergency call is received.

Additionally, in order to monitor and improve the quality of patient care by measuring outcomes, San Mateo is currently putting into place one of the most complete electronic patient care data systems of its type in the nation. When it is finished this year, AMR will have linked all fire departments, hospitals and ambulances from first response, in the ambulance, and through the emergency room outcome—all at no cost to the county. Why would AMR agree to all of this? Because, thus far, it is making a profit by doing so.

The results thus far are more than encouraging:

As with everything, however, there are cautions about adopting the San Mateo Plan.

AMR’s ambulance charges in San Mateo County are high, averaging $943 in 1999 and $990 currently, whereas AMR’s current average ambulance charges in Santa Barbara County are $640, or $350 less than San Mateo’s.

As noted, the San Mateo Plan was built around and financed by increased ambulance charges. It was adopted before the new Balanced Budget Act was passed. Since then the Health Care Financing Administration (HCFA) has proposed a dramatic decrease (up to 30%) in the fee structure for Medicare ambulance reimbursement rates. While the current Administration has put those decreases on hold, if they are adopted, the San Mateo Plan, which passes the costs of its first responder fire paramedic system on to the patients, may be in jeopardy without public subsidy.

Even so, adopting a Santa Barbara County-specific version of the San Mateo EMS Plan should be considered.

Contracting with the California Department of Forestry for Fire Protection

The Grand Jury met with the Deputy Director for Fire Protection and Deputy Chief, Contract Coordinator from CDF, as well as San Luis Obispo County’s Fire Chief, and a CDF Regional Chief, to discuss the possibility of CDF taking over all fire protection services in Santa Barbara County. The following is a summary of those discussions.

While CDF’s primary mission is protecting California’s timber and wildland resources, CDF provides complete fire protection services under contract to 35 of California’s 58 counties and many cities within them. In doing so, it operates

Additionally, CDF funds 82 fire engines and 12 bulldozers used in Kern, Los Angeles, Marin, Orange, Santa Barbara and Ventura Counties. In fact, one of Santa Barbara County's fire helicopters is leased from CDF. Its firefighters respond to an average of 7,500 wildland fires and nearly 300,000 other emergencies each year. CDF is usually brought in by local fire departments to coordinate and assist in fire suppression in major disaster situations such as the Painted Cave Fire.

CDF is also capable of providing EMS paramedic and ambulance services, and is doing so in San Mateo County. As one fire chief told the Grand Jury, "CDF will give Santa Barbara the best fire protection." He also noted, however, that the County had rejected two previous attempts to have CDF take over its fire protection, and that there was little likelihood that Firefighter Unions within Santa Barbara County would allow it to happen.

The reason for that statement seems to be that CDF firefighters work 72-hour weeks, whereas firefighters in Santa Barbara County and most other fire departments in the State work 56-hour weeks. It is that difference, among others, which usually enables CDF to provide fire protection services to 35 counties throughout the State at lower cost than local professional fire departments.

CDF has estimated that it could staff a fire department for Santa Barbara County with 16 fire stations. It would have a chief, a deputy chief, four battalion chiefs (field), three battalion chiefs (dispatch, training and administration), one fire captain (training), three fire captains (dispatch), three dispatch clerks, and one fire prevention assistant. In addition, it would have 48 fire station captains, two helicopter captains, 48 firefighters, 10 helicopter firefighters, one automotive fleet manager, two helicopter pilots, two heavy equipment mechanics, one finance clerk, and two clerical staff. The cost would be $6,783,138, plus an 11.13% CDF administrative charge of $754,763, or a total of $7,538,101.

County Fire’s current staffing costs, without the new major wage increases are $21,289,000, or almost three times higher than CDF’s staffing estimate for a somewhat comparable department without the limited paramedic or ambulance services that County Fire now provides.

Despite the political difficulty of exercising the CDF option, those numbers should give anyone pause before rejecting the CDF option out of hand.

In any event, the CDF representatives made it clear that while CDF would never seek to secure Santa Barbara’s business ("we aren’t in the business of hostile takeovers"), they strongly recommended that Santa Barbara County seriously consider the benefits of consolidating its fire-fighting services. Among the reasons given (in addition to those stated above) were that it would result in better insurance ratings and, consequently, in lower homeowner insurance rates.10

FINDINGS

Finding 1: There are nine separate and independent fire departments in Santa Barbara County.

Finding 2: There is no central emergency dispatch of any kind in the County.

Finding 3: There is no separate fire or emergency medical dispatch system within the County.

Finding 4: No emergency dispatching agency in the County can electronically or automatically communicate with any other dispatching agency in the County.

Finding 5: All inter-agency emergency communication in the County is done by telephone.

Finding 6: In 2000, the nine fire departments in the County responded to 25,078 emergency calls, of which 15,316 (or 61%) were for emergency medical services, 1,829 (or 7%) were for fire, is 1,356 (or 5%) were for hazardous materials, and 6,577 or 26% for miscellaneous calls.

Finding 7: The Sheriff’s Department provides primary dispatch for all ambulances, and provides primary dispatch to the County Fire Department as well as to the Solvang, Guadalupe, and Orcutt Fire Departments.

Finding 8: The Police Departments of the Cities of Santa Barbara, Santa Maria and Lompoc provide primary fire dispatch for their own fire departments within city boundaries; and the Carpinteria-Summerland and Montecito Fire Districts provide secondary dispatch to their fire departments in their geographic areas.

Finding 9: The Sheriff's Department and each of the Police Departments noted in Finding 8 have their own computer-assisted dispatch system, none of which can electronically "speak" to each other.

Finding 10: No emergency dispatch system in the County is capable of providing for automatic vehicle location.

Finding 11: The Santa Barbara Police Department has the only dispatch center in the County that provides pre-hospital/pre-arrival emergency medical dispatch instructions to the injured victim, or to the caller.

Finding 12: No pre-hospital/pre-arrival emergency medical instructions are provided to the vast majority of the County’s residents.

Finding 13: There is no structured caller interrogation or advanced prioritized dispatch system in place in the County. As a result, most emergency vehicles (fire and ambulance) are dispatched to the incident "Code 3" (i.e., with red lights and sirens).

Finding 14: There are no current methods in place to measure accurately fire paramedic or ambulance response times or effectiveness.

Finding 15: Emergency medical service in the County is provided by the County Fire Department (which provides advanced life support ambulance service to Vandenberg Village and New Cuyama, and paramedic service from its Goleta, Los Alamos, Santa Ynez and Orcutt Fire Stations); by American Medical Response (which provides advance life support ambulance service to the rest of the County); and by the Carpinteria-Summerland Fire Protection District (which provides paramedic service to its residents).

Finding 16: Centralization of fire and EMS dispatching, with prioritized and EMD, and automatic vehicle location (AVL) components, will provide far superior emergency medical services to the residents of this County than the existing six separate dispatch systems now provide.

Finding 17: Consolidation of all of the County’s nine Fire Departments into a single new and independent fire district will provide better, more efficient, and more cost-effective fire protection than the existing nine departments.

Finding 18: Because of the present disparity in tax revenues between the North and South portions of the County, separate North and South County Fire Districts do not appear to be financially viable at this time.

Finding 19: Fire department consolidations have worked in other counties.

Finding 20: The California Department of Forestry may be able to provide equivalent fire protection to the County’s residents at far low cost than is now being provided under the existing nine-department system.

Recommendations

Recommendation 1: That the Santa Barbara Local Agency Formation Commission (LAFCO), pursuant to Government Code Sections 56001 and 56301, review this report and findings in order to make recommendations on consolidation or reorganization of specific County services, including fire prevention and suppression services, evaluate the possibility of contracting with the California Department of Forestry (CDF) for all or part of these services, and centralized dispatch for fire and emergency medical response services in Santa Barbara County.

Recommendation 2: That LAFCO consider conducting its study into this matter utilizing a reorganization committee with participants from the affected parties and public agencies pursuant to Government Code Section 56833.

AFFECTED AGENCY

Santa Barbara Local Agency Formation Commission
All Findings and Recommendations


1EMS is a system of care for victims of abrupt and serious injury or illness. The system depends on the accessibility and synchronization of many different elements, ranging from an informed public able to recognize medical emergencies, to a network of hospitals providing specialized care to those injured. Critical elements necessary for the EMS system to work include 9-1-1 dispatchers, paramedics, ambulances, search and rescue teams, and pre-hospital and hospital emergency department staff. The EMS system integrates the police, fire, ambulance, and hospital emergency departments into a coordinated whole to save lives.

2Under new legislation (AB 1263) the CHP is authorized to allow local agencies to answer 9-1-1 cell calls. No agency in Santa Barbara County has been authorized to do so as yet. However, beginning October 2001, the Sheriff and other law enforcement agencies in the County may start taking 9-1-1 cell calls. In 2000 the CHP received over 6 million 9-1-1 cell calls statewide. 60% of them were either unnecessary or unintended, e.g., the 9 button on a programmed phone was inadvertently touched. The CHP answers 9-1-1 cell calls affecting Santa Barbara at two regional centers: in Ventura (which handles calls for South County) and San Luis Obispo (which handles calls for North County). 9-1-1 cell calls make up 65% and 34%, respectively, of all calls received by each of those offices. The CHP was unable to provide us the number of 9-1-1 cell calls relayed to any public safety agency in the County except for the most recent period of March 2001. During that month the Ventura office relayed 992, 9-1-1 cell calls to the Santa Barbara Police and Sheriff, and the San Luis Obispo office relayed 725, 9-1-1 cell calls to the Santa Barbara, Lompoc and Santa Maria Police and the Sheriff. Multiplying those figures by 12, there will be approximately 20,604, 9-1-1 cell phone calls relayed to and received by the various law enforcement agencies in the County this year. That is almost as many calls as were received by the various fire and EMS agencies in the County in 2000 over land lines. Handling those additional calls will severely tax the County's dispatching capacity. Effectively addressing that multi-jurisdictional problem is beyond the scope of this report and the Grand Jury's authority.

3"Emergency Medical Dispatch" is a process developed by a Dr. Jeffrey Clausen, in which written (on cards or on a computer program) protocols are used to prioritize calls for assistance and pre-arrival medical instructions (e.g., if and how to give CPR) are provided to the caller.

4County Fire's numbers are higher due in part to its performance of many functions of a regional nature such as providing helicopter evacuation, hazardous materials handling, and construction equipment to deal with forest fires. Additionally, each department calculates administrative expenses differently. For example, the City of Santa Barbara does not separately charge its Fire Department overhead.

5This labor cost will increase by approximately 36% over the next five years under the new firefighter labor contract with the County. That contract reflects wage rates paid by the City of Santa Barbara to its firefighters (the highest in the County at this time), and the addition of one firefighter to each fire engine to meet the new National Fire Protection Association (NFPA) and proposed Cal OSHA standard of having four firefighters per engine-the "two in two out" rule.

6 Isla Vista has a population of 18,344. UCSB has a daytime student-faculty population of approximately 25,000. They are the most highly congested areas in the county. UCSB is served by Fire Station 17, which is on the campus; and by Station 11 on Storke Road. Both are only three firefighter stations, which do not currently meet NFPA four men/engine standards. The Chumash Casino is next in congestion. Its existing 45,950 square-foot casino has an estimated capacity of 4,177 people 24 hours per day, seven days per week. Its new 21,600 square foot casino has an estimated capacity of 1,963 people 24 hours per day, seven days per week. The Grand Jury was unable to obtain occupancy figures from the Chumash, so those estimates are based on the 1997 Uniform Building Code public occupancy rule of one person for each 11 square-feet of space. Additionally, the Casino is building an 1,100 space parking structure, which will be the largest in the County. The Casino is owned by a sovereign Indian Nation which need not comply with any of the County's laws, yet the Chumash want fire protection. The Casino generates more than 25% of the Santa Ynez Fire Station's calls now. It seems reasonable for UCSB and the Casino to finance an additional firefighter at each of those stations for their own protection. On the other hand, both seem reluctant to do it. Accordingly, it may be in everyone's best interest to have each of them assume their own fire protection and EMS responsibility.

7 Law enforcement response usually calls for one or more patrol cars with officers properly advised as to the peril so as to protect themselves and others. Fire and EMS response may often require utilization of different types and numbers of vehicles and other equipment. For example, a fire suppression call may or may not need ambulance help; and a medical emergency may or may not need first response by a fire paramedic and/or follow up response by an ambulance. In either case, the dispatcher must know whether the response should be made by a rescue unit, fire engine, ladder truck, ambulance, or combination therof.

8 In "Making the Pieces Fit," a 1997 treatise on fire department consolidation, Chiefs Jack W. Snook and Jeffrey D. Johnson state: "Consolidation improves the efficiency and effectiveness of fire departments. It allows for better use of scarce resources, the reduction of duplicative efforts, and greater staff flexibility and capability." (p. 17)

9 While there is an excess based on 2000 County Fire Department costs, as noted those costs will increase dramatically in 2001 and later years due to the new labor contract for firefighters. So this excess may not be available even in 2002.

10 ISO ratings, upon which fire insurance premiums are based, range from 0 (the best), to 10 (the worst). The ISO ratings for Santa Barbara County range from 2 (in some parts of the City of Santa Barbara) to 9 (in many areas of North County like Sisquoc). For example, rural, hard to get to areas, are rated 9, and some well-protected urban, easy to get to and well covered areas, are rated 2. Most of the populated portions of the County are rated 4 to 5. If those ratings could be reduced to the 2 to 3 level, homeowner insurance rates should decrease accordingly.